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Contents

        Associate Editors ix
        Contributors xi

        Preface: Cutting-Edge Anesthesiology xxv

        Arna Banerjee, Richard P. Dutton, Francis V. Salinas, and Laurence C. Torsher

        Are Surgical Site Infections an Anesthesiologist's Problem? 1

        Philip J. Leisy, Robert D. Barnes, and Liza M. Weavind
         Introduction 1
         Perioperative antibiotics 2
         Antibiotic timing 2
         Antibiotic delivery 4
         Antibiotic concentration 6
         Other considerations 9
         Summary 11
         Conflicts of interest/disclosure 11

        Current Approaches to Resuscitative Endovascular Balloon Occlusion of the Aorta Use in Trauma and Obstetrics 17

        Linden O. Lee, Paul Potnuru, Christopher T. Stephens, and Evan G. Pivalizza
         Introduction 17
         Principles of resuscitative endovascular balloon occlusion of the aorta placement 18
         Physiology of resuscitative endovascular balloon occlusion of the aorta balloon inflation 20
        Cardiac 20
        Pulmonary 21
        Renal 21
        Mesenteric 21
        Cerebral and spine 21
         Reperfusion management in resuscitative endovascular balloon occlusion of the aorta 22
         Data for resuscitative endovascular balloon occlusion of the aorta in civilian trauma 22
         Data for resuscitative endovascular balloon occlusion of the aorta in obstetrics 24
         Risks and complications of resuscitative endovascular balloon occlusion of the aorta 25
        Arterial access 29
        Balloon placement and management 29
        Balloon deflation 29
        Removal of arterial sheath 29
         Summary 30
         Care points 30
        Disclosure 30

        Scratching the Surface: Endothelial Damage in Traumatic Hemorrhagic Shock 35

        Justin E. Richards, Ron E. Samet, and Thomas E. Grissom
         Introduction 36
         Endothelial glycocalyx structure 36
         Traumatic hemorrhagic shock and endotheliopathy of trauma 38
        Endotheliopathy of trauma 38
        Endothelial dysfunction and glycocalyx degradation in trauma 39
        Vascular barrier permeability and endothelial glycocalyx degradation 39
        Inflammation 40
        Coagulopathy 41
        Vascular tone and blood flow 42
        Endotheliopathy of trauma and organ failure 42
         Therapeutic options for endothelial dysfunction in traumatic hemorrhage 43
        Fresh frozen plasma 43
        Prothrombin complex concentrates and cryoprecipitate 45
        Tranexamic acid 46
         Summary 46
         Care points 47

        Optimizing a Surgical Practice from Start to Finish 53

        Adam W. Amundson, Adam K. Jacob, Chris M. Duncan, Alvin M. Tsang, Kathryn W. Zavaleta, and Hugh M. Smith
         Introduction: The need for change 53
         Practice optimization case study: The oasis projects 55
         Methodology for practice optimization: The roadmap to change 55
        Architecture 56
        Assessment 57
        Analysis 58
        Tactics 58
        Implementation 59
        Translation 59
         Lean and health system engineering tools and principles: Purpose and application 59
        Comprehensive coordinated care 60
        Eliminate non–value-added work 60
        Co-Locate 62
        Eliminate redundancy 62
        Decrease waiting on resources or personnel 63
        Standardization 64
        Simplify 65
        Communication and collaboration 65
        Use parallel processing 65
        Remove constraints 66
        Patient-centered care 67
        Develop an shared consciousness 67
        Continuous practice improvement 69
        Spotlight what is important 69
        Marginal gains add up 70
         Discussion: Lessons learned 70
        Motivated leadership 70
        The language of practice optimization 71
        The purpose of surgery 71
        Preoperative processes drive downstream flow and efficiency 71
        Teamwork and collaboration 71
        Data are king 71
        Every little bit helps 71
        Patient-centered care 71
        Every process and practice benefits from standardization 71
        Coordination and integration 71
        History does not have to repeat itself 72
        Practice optimization is not free or easy 72
        Gain institutional sponsorship 72
         Summary 72
         Care points 73
        Disclosure 73

        Perioperative Considerations for Person-Centered Gender-Affirming Surgery 77

        Luis E. Tollinche, William E. Rosa, and Christian D. van Rooyen
         Introduction 78
         Preoperative considerations 81
        History taking 81
        Estrogen 82
        Cyproterone acetate 83
        Spironolactone 83
        Testosterone 83
        Associated medical conditions and priorities 84
        Physical examination 85
         Facial feminization 85
         Vocal feminization 86
         Facial masculinization 86
         Chest binding 86
         Perioperative risk assessment 87
         Additional testing 87
         Intraoperative considerations 88
        Anatomic considerations 88
         Drug dosing 88
         Drug interactions 89
         Airway 89
         Postoperative considerations 90
        Pain 90
        Postoperative nausea and vomiting 90
         Cultural humility to guide person-centered gender-affirming care 90
         Summary 91
         Care points 92
        Disclosure 92

        Pushing the Envelope: New Patients, Procedures, and Personal Protective Equipment in the Ambulatory Surgical Center for the COVID-19 Era 97

        Steven Young, Richard J. Pollard, and Fred E. Shapiro
         Introduction 98
         Patient populations 98
         Ambulatory procedures 100
         Orthopedic surgery 100
         Endoscopy 100
         Plastic surgery 101
         Neurosurgery 101
         Thoracic surgery 102
         Gynecologic surgery 102
         Pediatric surgery 102
         COVID-19 103
         Postoperative outcomes in COVID-19 103
         COVID-19 testing 104
         COVID-19 vaccination 105
         Personal protective equipment in the age of COVID-19 105
         Case cancellation in the COVID-19 era 106
         Summary 107
         Care points 108
        Disclosure 108

        Perioperative Considerations for Patients with a Known Diagnosis of Dementia 113

        Julie R. Mcswain, Joel M. Sirianni, and Sylvia H. Wilson
         Introduction 113
         Dementia types, prevalence, and genetics 115
         Preoperative considerations 116
        Informed consent and ethical considerations 116
        Evaluating for common comorbid disease states 117
        Establishing multidisciplinary care and reviewing pharmacologic interventions 117
         Intraoperative considerations 120
        Impact of surgery and anesthesia on dementia 120
        General anesthesia 121
        Regional anesthesia 121
        Intraoperative medications 122
        Cerebral monitoring 122
        Modifiable risk factors 122
         Postoperative considerations 123
        Postoperative delirium 123
        Communication barriers 127
        Postoperative pain control 127
        Sleep disturbances 127
         Future directions 128
         Care points 128
        Disclosure 129

        Influence of Perioperative Handoffs on Complications and Outcomes 133

        Amanda Burden, Christopher Potestio, and Erin Pukenas
         Introduction 133
         Significance 134
         Communication: Briefing and debriefing 134
         The perioperative environment 135
         Standardizing handoff communication 136
         Teamwork 136
         Anesthesia handoff components (intraoperative and postanesthesia) 137
        The preoperative elements 137
         Surgical case elements 137
         The World Health Organization surgical safety checklist 137
         Intraoperative handoffs 138
         Postoperative handoffs 139
         Postoperative transitions to the intensive care unit 140
         Postanesthesia care unit (PACU) 141
         Transitioning the postprocedural patient from the postanesthesia care unit 141
         Summary 143
         Care points 144
        Acknowledgments 144
        Disclosure 144

        The Impact of COVID-19 on the Status of the Anesthesiologists’ Well-Being 149

        Rebecca Aron, Joseph Pawlowski, Mohanad Shukry, and Sasha Shillcutt
         Introduction 149
         Definition of burnout 150
         Prevalence of burnout in anesthesiology 152
         Contributors of burnout in anesthesiology 153
         Impact of physician burnout on institutions 154
        Patient effects 155
        Medical errors 155
        Financial implications 156
         Impact of burnout on individuals 157
         Consequences of COVID-19 on burnout in anesthesiology 157
        Financial impact 158
         Identifying burnout in anesthesiology departments 159
         Am I burned out or just stressed? 160
         Prevention of burnout and emotional exhaustion from COVID-19 160
        Individual 161
        Team 161
        Institutional 161
         Strategies to recover from burnout 162
         Developing well cultures 162
         Summary 163
         Funding source 164
        Disclosure 164

        Neuromuscular Blockade Monitoring and Reversal: A Clinical and Pharmacoeconomic Update 169

        Wade A. Weigel and Stephan R. Thilen
         Introduction: nature of the problem 169
        Assessment of Depth of Neuromuscular Blockade 171
         Indications/contraindications 176
         Complications and management 177
         Reporting, follow-up, and clinical implications 177
         Outcomes 183
         Current controversies/future considerations 184
         Summary 184
         Care points 185
        Disclosure 185

        Perioperative Point-of-Care Ultrasound 189

        Melissa Byrne, Michael Singleton, Hari Kalagara, and Stephen C. Haskins
         Introduction 190
         Airway ultrasound 190
        Brief clinical case 190
        Background 191
        Clinical case revisited 193
         Lung ultrasound 193
        Brief clinical case 193
        Background 193
        I-AIM framework 194
        Clinical case revisited 198
         Abdominal/pelvic ultrasound (fast examination) 198
        Brief clinical case 198
        Background 199
        I-AIM framework 199
        Clinical case revisited 200
         Gastric ultrasound 204
        Brief clinical case 204
        Background 204
        I-AIM Framework 205
        Clinical case revisited 205
         Focused cardiac ultrasound 205
        Brief clinical case 205
        Background 205
         Summary 211
         Care points 211

        Regional Anesthesia for Cardiac Surgery: A Review of Fascial Plane Blocks and Their Uses 215

        Matthew J. Ritter, Jon M. Christensen, and Suraj M. Yalamuri
         Introduction 215
         Background 216
         Thoracic fascial plane blocks 217
         Transversus thoracis muscle plane block 217
        Background 217
        Current evidence 217
        Indications 218
        Contraindications/complications/limitations 218
        Anatomy and technique 219
         Pectointercostal fascial plane block 220
        Background 220
        Current evidence 221
        Indications 221
        Contraindications/complications/limitations 222
        Anatomy and technique 222
         Pectoralis nerve block 223
        Background 223
        Current evidence 224
        Indications 224
        Contraindications/complications/limitations 225
        Anatomy and technique 225
         Serratus anterior plane block 226
        Background 226
        Current evidence 226
        Indications 227
        Contraindications/complications/limitations 227
        Anatomy and technique 227
         Erector spinae plane block 228
        Background 228
        Current evidence 229
        Indications 230
        Contraindications/complications/limitations 230
        Anatomy and technique 231
         Discussion 231
         Summary 234
         Disclosure 235
         Care Points 235
         Supplementary Data 235

        Simulation Training for Crisis Management: Demonstrating Impact and Value 241

        Huong Tram Duran and William McIvor
         History Of crew resource management in anesthesia 241
         Classic crisis resource management 242
         The checklist 242
         Advanced cardiovascular life support 243
         Anesthetists nontechnical skills system, an early alternative model of crisis resource management 244
         Simulation education in obstetric emergencies 245
         Team strategies and tools to enhance performance and patient safety 246
         Simulation in times of public health crisis 247
        Severe acute respiratory syndrome 247
         Simulation in continuing professional development 249
        Simulation-based learning of new techniques and procedures 250
        Patient safety initiative 252
         Challenges in integrating crisis resource management training with simulation into practice 253
         Catalyst for lifelong learning 254
        Disclosure 255

        Telehealth in Anesthesia 259

        Adam K. Jacob, Lisa M. Belch, and Sher-Lu Pai
         Introduction 259
         Advantages of virtual preoperative encounters 261
        Process efficiency 261
        Patient and provider experience 261
        Clinical outcomes 261
        Cost savings 262
         Approach to preoperative telemedicine 263
        Stakeholders 263
        The “previsit” visit 263
        Method of contact 263
        Patient selection 264
        Documentation and billing 265
         Limitations and risks of telehealth 265
        Medical licensure 265
        Patient comfort, capability 265
        Network availability 266
        Physical examination 266
        Preoperative testing 266
        Security and health insurance portability and accountability act 266
         Summary 266
         Care points 267
        Conflicts of interest 267
        Disclosure 267

        Anesthesia for Fetal Interventions - An Update 269

        Monica Hoagland and Debnath Chatterjee
         Introduction 269
         Anesthetic management considerations 272
        Preoperative assessment and multidisciplinary coordination 274
        Anesthetic requirements 276
        Uteroplacental perfusion and uterine tone 278
        Fetal assessment 279
         Anesthetic techniques 279
        Preoperative management 279
        Anesthetic management 280
        Management of uterine tone 281
        Fetal monitoring and resuscitation 283
         Emerging trends 284
        Neurotoxicity concerns 284
        Role of dexmedetomidine 285
        Fetoscopic myelomeningocele repair 285
         Summary 286
         Care points 287
        Disclosure 287